Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.74 / $92.52 / $178.58	Facility	26	$55.74	$92.52	$178.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $318.73 / $476.13 / $952.26	Professional		$318.73	$476.13	$952.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.85 / $55.74 / $139.08	Professional	26	$45.85	$55.74	$139.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $272.87 / $420.39 / $837.17	Professional	TC	$272.87	$420.39	$837.17
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.35 / $79.73 / $96.64	Professional	26	$27.35	$79.73	$96.64
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $66.59 / $116.00 / $2,533.52	Facility	26	$66.59	$116.00	$2,533.52
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $490.16 / $837.33 / $2,348.14	Professional		$490.16	$837.33	$2,348.14
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $67.91 / $116.58 / $379.76	Professional	26	$67.91	$116.58	$379.76
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $433.82 / $720.75 / $2,034.68	Professional	TC	$433.82	$720.75	$2,034.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $451.99 / $766.14 / $1,220.73	Professional		$451.99	$766.14	$1,220.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.42 / $104.23 / $163.69	Professional	26	$65.42	$104.23	$163.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $386.57 / $660.57 / $1,057.99	Professional	TC	$386.57	$660.57	$1,057.99
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $62.38 / $121.64 / $3,926.54	Facility	26	$62.38	$121.64	$3,926.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $352.16 / $823.94 / $1,082.16	Professional		$352.16	$823.94	$1,082.16
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $62.38 / $120.52 / $148.11	Professional	26	$62.38	$120.52	$148.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $304.11 / $711.76 / $945.82	Professional	TC	$304.11	$711.76	$945.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $49.85 / $411.17 / $812.22	Professional		$49.85	$411.17	$812.22
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $76.44 / $97.87 / $99.96	Facility	26	$76.44	$97.87	$99.96
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $857.90 / $857.90 / $857.90	Professional		$857.90	$857.90	$857.90
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $62.16 / $78.00 / $106.46	Professional	26	$62.16	$78.00	$106.46
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $374.38 / $476.25 / $599.96	Professional	TC	$374.38	$476.25	$599.96
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $66.59 / $66.59 / $67.64	Facility	26	$66.59	$66.59	$67.64
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $546.05 / $808.84 / $991.98	Professional		$546.05	$808.84	$991.98
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $76.03 / $114.55 / $138.72	Professional	26	$76.03	$114.55	$138.72
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $470.04 / $696.22 / $851.09	Professional	TC	$470.04	$696.22	$851.09
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,526.97 / $1,526.97 / $2,533.52	Facility	26	$1,526.97	$1,526.97	$2,533.52
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $501.73 / $725.77 / $1,002.46	Professional		$501.73	$725.77	$1,002.46
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $82.27 / $102.42 / $138.43	Professional	26	$82.27	$102.42	$138.43
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $496.97 / $632.51 / $872.97	Professional	TC	$496.97	$632.51	$872.97
United Facility/Professional Professional Modifier Low / Median / High Price $301.60 / $378.23 / $1,009.85	Professional		$301.60	$378.23	$1,009.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.70 / $56.17 / $140.59	Professional	26	$45.70	$56.17	$140.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $256.56 / $325.57 / $924.64	Professional	TC	$256.56	$325.57	$924.64